Oncological Outcomes After Radical Cystectomy for Bladder Cancer: Open Versus Minimally Invasive Approaches

Purpose

The number of centers performing robotic assisted radical cystectomy has recently increased, spurring greater concerns about oncological outcomes. In this review we summarize the most comprehensive articles published on the oncological outcomes of laparoscopic assisted, robotic assisted and open radical cystectomy.

Materials and Methods

A MEDLINE®/PubMed® literature search was conducted in March 2009 to review English language articles published from 1998 onward. Of 217 selected articles on the 3 techniques 19 studies were selected for this review.

Results

The laparoscopic series reported recurrence-free survival rates in the range of 83% to 85% at 1 to 2 years and 60% to 77% at 2 to 3 years, while the robotic assisted studies reported recurrence-free survival rates of 86% to 91% at 1 to 2 years. Large open surgery studies showed 62% to 68% recurrence-free survival at 5 years and 50% to 60% at 10 years, with overall survival of 59% to 66% at 5 years and 37% to 43% at 10 years. Overall survival in the laparoscopic cohorts was 90% to 100% at 1 to 2 years and 50% to 87% at 2 to 3 years. Publications reporting robotic cases demonstrated a 90% to 96% overall survival in 1 to 2 years of followup.

Conclusions

Despite the surge of centers adopting minimally invasive approaches for radical cystectomy, the long-term effectiveness of these techniques has not yet been proven. This review of recent and landmark articles on open and minimally invasive procedures emphasizes the need for prospective controlled studies and long-term followup data to determine the proper use of laparoscopic and robotic assisted techniques in bladder cancer surgery.

Key Words: urinary bladder neoplasms, cystectomy, surgical procedures, minimally invasive, laparoscopy, robotics

Abbreviations and Acronyms: Cis, carcinoma in situ, CSS, cancer specific survival, ECIC, extracorporeal ileal conduit, ECONB, extracorporeal orthotopic neobladder, IC, ileal conduit, LND, lymph nodes dissected, LRC, pure laparoscopic or laparoscopic assisted radical cystectomy, ONB, orthotopic neobladder, ORC, open radical cystectomy, OS, overall survival, PLND, pelvic lymph node dissection, RC, radical cystectomy, RFS, recurrence-free survival, RRC, robotic assisted radical cystectomy